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Voice hoarseness/dysphonia (others (spasmodic dysphonia (dysphonia during…
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Treat only if
- dysphonia + URTI > 3 weeks
- dysphonia only > 2 weeks
Inx
- physical exam: ENT, respiratory, thyroid, LN, neuro
- FBC, renal panel
- respi swab/sputum gram stain & culture/blood culture
- flexible nasoendoscopy - look at structure & mobility/ biopsy
- videostroboscopy - if nasoendscopy does not detect pathology
- TFT
- CT brain/CXR/thyroid U/S/rNST/fEMG
- pan-scan work up (laryngeal Ca)
Mx:
- ABC - intubation if required, IV drip
- monitor vital signs
- admit to ICU for workup
- non-pharm: lifestyle modification (GERD, occupation, smoking cessation)
- pharm: Abx, levothyroxine, carbidopa, pyridostigmine/IVIG
- surgical: thyroidectomy with RAI, lung resection
- referral to med onc, surg onc, neuro